When it comes to medical billing, even the most experienced departments can end up experiencing denials of claims. Thankfully, when you are able to know the most common mistakes in medical billing, you will be able to take all of the necessary steps needed in order to successfully avoid them.
Here are four of the most common mistakes that are often encountered involving medical billing.
While any information that is missing can oftentimes be the cause of a claim being denied, some of the most commonly-missed informational items include the following:
*Date of the accident
*Date of the medical emergency
*Date of the onset
It’s important to note that you should always take the time to scrutinize every claim for missing fields, as well as all supporting types of documentation that are required.
Coding Isn’t Specific Enough
Every diagnosis is required to be coded to the highest level for that particular code. This means that, for instance, in ICD-9, the code used for diabetes was 250.0, and the fifth digit is used to help indicate the specific type of diabetes that someone suffers from. On the other hand, the code ICD-10 shows that the equivalent code is E10.649. The smallest mistake in medical billing can have drastic effects on the billing.
Code Isn’t Filed on Time
A claim can typically end up getting denied if it’s submitted, yet it isn’t done so within a specific timing window. Currently, the Affordable Care Act mandates that the claims-submitted period has been reduced to 12 months, having previously been set at being between 15 and 27 months. This is a policy that Medicare providers should specifically make note of.
Patient Identifier Information is Incorrectly Noted
The best way to avoid this type of error is to always double-check the following:
*Ensure that the name of the patient is correctly spelled
*The patient’s sex and date of birth are accurate
*The patient’s correct insurance payer is entered
*The patient’s insurance policy number is valid
*The claim filed by the patient requires a group number
*There is an accuracy in the patient’s relationship to the insured person
*The actual diagnosis code matches the procedure that was performed on the patient
*The primary insurance is what’s listed in case multiple insurances are listed
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